The Makous Protocol

“Shaking it Up” with New and Creative Internal Neuromuscular Electrical Stimulation

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*****Please do not take this class in the Teachable App*****

The Makous Protocol.“Shaking it Up” with New and Creative Internal Electrical Stimulation. A Unique and Effective Intra-vaginal and Intra-anal Physical Therapy Strengthening Protocol.

It is an original protocol created by Elizabeth Makous, a Pelvic Floor Physical Therapist for over 26 years.

To my knowledge there is no other Internal Electrical Stimulation (IES) Protocol in the literature that uses the IES as I have used it and present herein.

The Makous Protocol is a method of Internal Electrical Stimulation that has helped thousands of patients respond faster to traditional pelvic health therapies as well as to heal bowel, bladder, and sexual dysfunctions of those who have not responded to traditional physical therapy or medical treatments!

Fellow clinicians please sign up for my course so I can take you on a journey that imparts to you the lessons I have learned, the knowledge I have gained and the evidence-based research available to understand the Makous Protocol. You too may help your most desperate patients heal with the Makous Protocol! I promise you it will be transformative to your clinical practice!

Course Objectives:

  • Describe why a therapist should choose the Makous Protocol.
  • Describe the Makous Protocol progression, compliance, and relapse.
  • How I determined the parameters of the Makous Protocol.
  • Describe traditional IES Protocols and Parameters based on literature and textbook reviews.
  • Describe my theory of how traditional protocols and parameters were developed.
  • Present Research Indicating the ineffectiveness of traditional IES Parameters.
  • Bonus section: Describe my clinical approach to using Internal and External ES for pelvic as well as head and neck cancer patients.
  • Describe the factors that facilitate the clinical effectiveness of the Makous Protocol.
  • Describe how to determine which patient is appropriate for the Makous Protocol.
  • Relative Contraindications and Contraindications to using the Makous Protocol.
  • Describe therapist requirements:
  • Ability to make an accurate physical therapy diagnosis
  • Sound clinical reasoning skills
  • Ability to be creative with wisdom
  • Provide extensive clinical examples of the power of the Makous Protocol to be creative in meeting the needs of many patient populations.
  • Summarize my theories of why the Makous Protocol works.
  • Provide a video demonstration presenting details of how I educate my patients to use The Makous Protocol at home.
  • Case Studies

Case Descriptions:

Two cases will be presented to help the therapist understand the power of using the Makous Protocol to strengthen the entire pelvic floor vaginally or rectally.

One case study will be of an 84-year-old female with severe Grade 3 Cystocele (Stage IV based on POP-Q) causing urinary urge incontinence (UUI) and hesitancy with retention if she does not strain the get urine out.

The second will be of an 80-year-old male with severe urinary incontinence (UI), chronic urinary tract infections (UTIs), and erectile dysfunction (ED) caused by a Transurethral Resection of the Prostate (TURP) performed three years prior. The patient uses a penile clamp, condom catheter or adult diaper at all times. Other complicating factors include history of open heart surgery, hernia repair, and chronic pain and constipation due to Rheumatoid Arthritis

His current medications include methotrexate, prednisone, daily baby aspirin, vesicare, and hydrocodone.

I will describe in detail how my protocol is used in each case to resolve the patient’s symptoms.

Case Outcomes:

In Case 1, the patient reported complete resolution of urinary symptoms and a 75% reduction in prolapse (Grade 1 or Stage II) after only 8 sessions of almost once a week therapy, and the Makous protocol of IES at home.

In Case 2, the patient reported total remission of urinary incontinence with only 2 to 3 drops of urine leakage a day, elimination of recurring UTIs, and regaining of erectile and ejaculatory function with ongoing use of anal IES using the Makous Protocol. This only required 11 treatment sessions and 11 weeks of the Makous Protocol with significant improvement after only 9 weeks.

  • Need for Future Studies discussed.
  • Peer Reviewed References. Posted at the end of the lessons in the Additional Comments section

Your Instructor

Elizabeth Makous MSPT CLT PRPC CES
Elizabeth Makous MSPT CLT PRPC CES

I have been a Pelvic Health Therapist since 1992. My career has been focused on helping patients with very complicated bladder, bowel and sexual dysfunctions and pelvic pain. Along with the Pelvic Health specialty I have two certifications in edema and lymphedema management. Merging specialized treatment of the lymphatic system with the musculoskeletal system enhances treatment effectiveness and facilitates healing in patients with complicated issues. This is remarkably true when I treat cancer patients.

I have always enjoyed learning from and mentoring colleagues within my current position as Coordinator of the large Pelvic Health and Lymphedema Program at Henry Mayo Hospital Fitness Center (Valencia, CA).

Other mentorship include being a TA for Herman and Wallace Pelvic Rehabilitation Institute as well as Norton School of Lymphology.

I have also enjoyed volunteering my time to review and edit handouts for the Pelvic Guru’s website as well as serving as a consultant for Therawand and other start up companies.

I have had the honor of going on two medical mission trips to Kenya where I was privileged to serve impoverished men and women with pelvic pain and many other physical dysfunctions. The focus of our 2021 trip was to rescue girls from Female Genital Mutilation (FGM) and for me to discover how to treat the consequences of FGM. I continue to mentor and raise funds for the medical clinics in Moheto.


University of Florida - Bachelor of Science in Neurobiological Sciences
Masters of Exercise and Sports Sciences in Exercise Physiology
Bachelor of Science in Physical Therapy, 1992 (Highest Honors)


Certified Lymphedema Therapist (CLT)-

Norton School of Lymphology, 2012

Pelvic Rehabilitation Practitioner Certification (PRPC)-

Herman and Wallace Pelvic Rehabilitation Institute, 2014

Certified Edema Specialist (CES)-
North American Seminars, 2018

Certified Clinical Instructor (CCI)-


Course Curriculum

  The Makous Protocol-total time approx 4 hours
Available in days
days after you enroll

Frequently Asked Questions

When does the course start and finish?
The course starts now and never ends! It is a completely self-paced online course - you decide when you start and when you finish.
How long do I have access to the course?
How does lifetime access sound? After enrolling, you have unlimited access to this course for as long as you like - across any and all devices you own.
What if I am unhappy with the course?
We would never want you to be unhappy! If you are unsatisfied with your purchase, contact us in the first 30 days and we will give you a full refund.
Will I get CCUs or CEUs for this class?
Every effort is being made to attain approval for CCUs or CEUs. To assist with this, you are required to sign up for this course with your professional license number as your middle name and your degree and certification acronyms following your name. Just like this. —-Elizabeth 23349 Makous MSPT CLT PRPC CES.
Do I have to be a licensed PT, OT, MD, or nurse?
Yes. This course is designed for medical professionals to be incorporated into their clinical practice.
Do you give clinic discounts?
Yes! 25% discount for clinics of 2-4 clinicians and 30% discount for clinics of 5 or more clinicians. Email Elizabeth at [email protected] for your personal group discount code.
By taking this course you have agreed to practice professional integrity by not teaching or sharing this information or sharing your password with other therapists without them legitimately and honestly taking the entire course.

If you have already learned the Makous protocol parameters through other clinicians that I have trained prior to formalizing this course, please take the class to ensure best clinical practice!

This is the only way to ensure the safety of the patients in which therapists are applying the Makous Protocol. I have chosen not to release the Makous Protocol parameters freely because without being trained in the extensive clinical dimensions of evaluation and treatment as detailed and presented in the course, outcomes will not be optimal.

Furthermore, all material presented herein is copyrighted with the United States Register of Copyrights and Director.

Registration Number: TXu 2-145-936

Effective date of Registration: 4/28/2019

Previous registrations and year: TXu 2-080-567, 2017; TXu 2-137-337, 2019.

Having said that, I will commit to pursuing attainment of clinical CEUs for this course. Once I attain status I will notify all those who have taken this course.

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